A Payment Quandary for Medicine and Social Media

These days I spend a lot of time reading other doctors’ and patients’ blogs and Twitter posts. One recurring theme is the use of Social Media to improve wellness in our patients. This is a great idea and I’m excited to participate especially when the data shows that patients who are on social media are already getting heath advice: PricewaterhouseCooper:

But who will pay for this? More specifically, who will pay ME for this? Much as I enjoy answering patient emails, would love to have a professional Facebook presence and am happy to Twitter; all these things take time. And time is not something any primary care doc has much of. Since I do enjoy a life outside of the office, including learning a new language, spending time with my family, trying to exercise a MINIMUM of five days of the week, plus bear primary responsibility for feeding my husband and daughter, and would dearly love to read a book on occasion; in the absence of an obvious ROI (return on investment) to present to the healthcare system that employs me, how do I find the time during working hours to do these things and not get paid? My contract specifically defines how much “face-to-face patient contact” I must have. As long as the present reimbursement system persists when I’m not in physical contact with a patient I am not generating income.

As with any service industry it is difficult for our “clients” (I HATE that word, I have patients not clients), to understand that my pay is directly affected by how many people I see every day, or more specifically, how many RVU‘s that I generate on a daily basis. This is directly tied to how “sick” a patient is. So the sicker the patient, the more I can charge. Wellness? With the exception of ONE “well” visit per year for the commercial insurance patient, I am not paid to promote wellness or good health at all. Of course I try to throw that in with every patient visit but until primary care undergoes the revolution that it needs and deserves, prevention is not something I can afford to spend a lot of time on with patients.

And that truly, to use the vernacular, sucks. There are doctors out there doing it “right”, who have left the traditional practice model to become concierge doctors and by all reports these professionals are happier and more fulfilled in their jobs. My expectation is that this is the reimbursement model we will see in the future but in the meantime, how do I find the time to give patients what they want before they or the insurance companies and/or employers and/or government is willing to pay for that time?